Screening for distant metastases in head and neck cancer patients

The search for distant metastases in head and neck cancer patients, at the time of initial presentation and evaluation, is justified in order not to subject a patient to radical local therapy if cure cannot be attained. This study reviews 897 consecutive cases of squamous carcinoma of the larynx, oropharynx, hypopharynx and oral cavity, presenting to the Department of Otolaryngology--Head and Neck Surgery. One hundred and twenty-one patients presented with advanced disease or other factors that suggested distant metastases were highly likely to be present. These patients underwent extensive metastatic work-up, consisting of biochemical profiles, liver scan, bone scan and chest X-ray. The value of this extensive evaluation is assessed in terms of the patient-derived benefit, rather than the traditional incidence of metastases and predictive accuracy. Evidence of metastases was identified in 15 patients (12.4%) of this high risk group, but were of significance in the selection of appropriate therapy in only three patients (2.5%). Due to shortcomings in the investigative modalities currently in use and difficulties in their interpretation, erroneous therapeutic decisions were made in two of these three cases. In view of this low positive yield, the rationale between routine screening in head and neck cancer is discussed with its effect on therapeutic decisions.